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Medical-Acute Care

what does oxygen delivery (DO2)depend on in order to give tissues oxygen to survive? adequate vintilation, gas exchange and circulatory distribution
what are the two main categories resulting from tissue hypoxia ? arterial hypoxaemia and failure of the oxygen-haemoglobin transport system without arterial hypoxaemia
what are six pathophysiological mechanisms that cause arterial hypoxaemia? Low inspired oxygen partial pressure (PO2), hypoventiliation, shunt, ventilation/perfusion mismatch (V/Q), imparied diffusion, venous saturation
what are clinical featrues of tissue hypoxia? non specific factors that include AMS, syspnoea, hyperventilation, arrhythmias and hypotension.
what do you call the rightward shift of the dissociation curve that ensures adequate tissue DO2 in chronic hypoxia? compensatory mechanisms
what defines the oxygen hemoglobin relationship? Arterial Oxygen Tension and hemoglobin saturation are inversely related and modified by Temp, PH, and 2,3 diphospoglycerate
what is the difference b/w arterial tension and arterial saturation? PaO2 is the tension driving oxygen into tissues and arterial So2 reflects the level of oxygen carriage by haemoglobin molecules
when PaO2 and SaO2 are used to adjust oxygen therapy, what factor can trick the criteria for adjustment? Low CO, anemia, or failure of oxygen utilization.
For low CO, anemia, or failure of O2 utilization what is the best indicator of inadequate tissue DO2?` Mixed venous oxygen saturation (SvO2) <55-60% (normally >70%) reflects inadequate DO2.
what condition is defined as an arterial oxygen <8 kPa or arterial carbon dioxide (PaCO2) >6kPa acute, chronic, or acute on chronic Respiratory failure (RF) due to inadequate gas exchange.
what are the two types of respiratory failure? Type 1: due to failure to oxygenate Type 2: due to failure to ventilate
what are seven indications for intubation? RR>35, PaO2 < 8kPa on > 50% FiO2, PaCO2 >7.5 kPa, PH < 7.25, decreased conscious level (GCS <8), inadequate secretion clearance, exhaustion and failure to improve within 1-4 hours with NIV
what should be prescribed on the drug chart, signed for by the doctor, and documentedby the nursing staff at each drug round? dose, delivery method, duration, target saturation, potential benefits, side effects and indications for drug therapy.
what is therapeutic aim of oxygen therapy guided by? Hyper Capnic Respiratory Failure, low risk in normal pts, high risk in COPD, pneumonia, neuromuscular disease, chest wall disorder, morbid obesity, cystic fibrosis, exertional dyspnea w/o other cause of breathlessness
in pts at risk for HCRF what results from a higher SaO2 (>88%-92%)? hypoventilation, hypercapnia and respiratory acidosis in pts dependent on hypoxaemic respiratory drive.
on low dose controlled supplemental oxygen, what is the exception to the therapeutic adjustment? if PaCO2 is normal , SaO2 is adjusted to 92%-98% and ABG checked on the hour, unless pt is prior HCRF.
what are risks associated with high dose oxygen therapy? CO2 retention, Rebound hypoxaemia, Absorption collapse, Pulmonary oxygen toxicity, Fire, Paul-Bert Effect (hyperbarric O2 can cause cerebral vasoconstriction and epileptic effect)
when is oxygen therapy safely discontinued? when the pt is clinically stable on low dose oxygen (1-2 LPM), and SaO2 is within the desired range on two consecutive occasions. Monitor SaO2 for 5 minutes after stoping oxygen and recheck at 1 hour.
what are other techniques to improve oxygenation? Blood Transfusion for anaemia, bronchoscopy and mucolytics for secretion retention, alveolar edema in ARDS is reduced by fluid restriction, V/Q mismatch and shunt is reduced by alveolar recruit, vent support corrects hypoventilation/hypercapnia
what are two benefits to positive pressure Non invasive ventilation? PPNIV avoids pulmonary infection, reduces pressure damage and allow time to decide if MV is appropriate
what are two limitations to PPNIV? It may lead to gastric dilation which requires suction from an NG tube, impedes sputum clearance, and may cause ulceration over nasal bridge.
what are some factors associated with success of an NIV? Conscious level of awareness, improvement of PH PaCO2, and RR within 1 hr of NIV.
what are factors associated with failure? PH , 7.25, copious resp secretions, High APACHE score
What is an APACHE score? The Apache-II Score provides an estimate of ICU mortality based on a number of laboratory values and patient signs taking both acute and chronic disease into account. (mdcalc.com)
If a PaCO2 remains elevated in a pt with NIV what should you do? increase IPAP or decrease EPAP
Created by: redhawk101